Oh My Aching Back – Or Is It My Hip?

Back problems can masquerade as hip problems and vice versa. “There is a lot of overlap,” says US orthopedic physician Frank Lorch, M.D. Most pain from hip and back problems is not dangerous and is usually due to ordinary wear and tear on the body. However, when you don’t know what is causing the pain, you are at risk of receiving the wrong treatment.  As the only board-certified sports medicine and pain physician in China, Dr. Lorch is used to working with patients who don’t know what causing their pain – they only know they are in pain. Fortunately, Dr. Lorch specializes in diagnosing the source of pain and then working with his partners, spine and pediatric orthopedic specialist Dr. Edward Southern and sports and joint specialist Dr. Frank DiFazio to treat them.

When the hip is the usual suspect?

Somewhat confusingly, many people refer to their buttock region as their “hip”. Hip joint problems usually produce groin pain on the affected side, but occasionally the joint can also refer pain to the buttock and low back. That’s because the actual joint of the hip is deep in the pelvis. “Groin pain is a hip issue until proven otherwise,” says sports and joint specialist Dr. Frank DiFazo. “Pain above the belt line is not a hip issue.”

It is not uncommon for the hip joint to even refer pain to the knee, especially in children with problems of the open growth plates in the hip, Dr. Southern notes.

The most common cause of hip pain in adults is osteoarthritis of the hip joint. You may have hip arthritis if:

  • Pain is in your groin;
  • Discomfort comes and goes, becoming more frequent over time;
  • Pain worsens with standing, walking and activity, and is relieved by rest;
  • You feel stiff;
  • You walk with a limp.

When the spine is the likely culprit

Most lower spine problems are due to a herniated disc, thickened ligaments or bone spurs which press on nerves in the spinal column. This often produces the pain known as sciatica, which can be felt in the hip.  Dr. Southern finds that patients in China often come to him after living with this excruciating pain for months, and sometimes years, and only after TCM and regular massages fail to relieve the pain. Such treatments don’t hurt you but have been shown to not have much effect on these problems. Patients are reluctant to seeing an orthopedic specialist, but in an ethical practice, is only a small minority of the patients who ever end up in the operating theater. Dr. Lorch estimates that more than 95% of his group’s patients avoid surgery.

You may have a herniated disc or another related spine problem if your pain:

  • Involves your back, buttocks or hip;
  • Shoots down your leg;
  • Worsens with sitting or bending;
  • Improves when standing or walking.

If you have night sweats, a history of cancer, pain that is not relieved by lying down or pain worse at night, see your doctor — the problem may be more serious.

Some people develop what Dr. Lorch calls a “double whammy” — problems in both the hip and lower back. “It’s not surprising, since both osteoarthritis and spinal changes are more common as we age” he explains.

To relieve hip pain, try these first:

  • Over the counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and some not too strenuous stretching exercise often relieve pain if it is caused by over use.
  • Start exercising/Lose weight: Shedding extra pounds is critical in relieving hip pain – particularly when part of an overall health regime stressing regular exercise and good nutrition. “Getting fitter and losing weight often reduces symptoms to the point where surgery is not necessary,” says Dr. Lorch. “It also increases your chances of a successful outcome if surgery is one day warranted.

For back pain problems, try these first:

  • As with hip pain, NSAIDs such as ibuprofen are often helpful. Meanwhile, stay active! “Activity can and should be continued. Prolonged bed rest (more than 24 to 48 hours) is bad advice,” says Dr. Lorch.

When to go to the doctor:

  • If you’re still in pain after two to three weeks, an orthopedic specialist can ensure that there is nothing serious going on and first and foremost, determine the real source of your pain.

Adolescents and older children are often seen in our clinics with long standing low back pain; pain in the back in a young person is NEVER normal and at best is a sprain. In several studies, it is found that children involved in sports frequently and complaining of back pain for more than 3-4 weeks have a very high incidence of a stress fracture in the spine!

For both kids and adults, the first and the most important step is ALWAYS to get a good, precise diagnosis based on imaging studies and find out what is actually causing your pain. Dr. Lorch often works with patients as they start their journey to pain relief. First he determines the actual injury than he as array of tools he can use to treat patients non surgically:  He can use lidocaine when performing a diagnostic and therapeutic hip injection under fluoroscopy or ultrasound guidance. If the problem is the hip, this will numb the hip joint and relieve symptoms almost immediately. “If the pain does not improve, we know we’re barking up the wrong tree,” says Dr. Lorch. The same technique can rule out or confirm back pain.  Then he works with physical therapists and/or chiropractors to help treat patients conservatively but if circumstances demand it, he works with his surgical partners Dr. Southern and Dr. DiFazio to make sure that modern minimally invasive surgery is available.